title: Barriers to treatment engagement for depression among Latinas.
abstract: In spite of successful treatment options for depression, the majority of Americans with severe depression do not receive treatment. Latinos are even less likely to engage in treatment than non-Hispanic Whites. The purpose of this study is to explore barriers to treatment engagement and, more specifically, how childhood adversity and gender-based violence (GBV) contribute to a lack of perceived support for treatment engagement. Experiences of GBV and childhood adversity can call into question deeply held family, cultural, and religious values, and affect the perceived quality of the therapeutic relationship and attitudes about depression treatment. A qualitative descriptive methodology was used to understand the experiences of a sample of 12 Latinas who were part of a diabetes prevention study (n = 67) and had been referred for treatment because of elevated symptoms of depression. Results indicate that the often-cited barriers to mental health care (i.e., language barriers, economic considerations, and lack of illness recognition) did not serve as deterrents for Latinas in this study. Participants recognized that they were depressed and agreed with the assessment of depression. However, none of the women followed up on the recommendation to seek care. What has emerged from this study is how cultural values, such as familismo and marianismo, and the lack of responsiveness from family and religious leaders in the context of exposure to GBV and childhood adversity created significant barriers to treatment engagement. This study highlights the need for nurses to screen for these exposures and to engage in shared decision making about treatment.
authors.affiliation: Rutgers University, The State University of New Jersey, College of Nursing, Newark, New Jersey 07102, USA. susan.caplan@rutgers.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Caplan
authors.forename: Robin
authors.initials: R
authors.lastname: Whittemore
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002650:Child Abuse, Sexual / Q000523:psychology; D003144:Communication Barriers; D003466:Cultural Characteristics; D003866:Depressive Disorder / Q000208:ethnology* / Q000451:nursing* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000451:nursing / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005783:Gender Identity; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D064691:Nurses, Community Health; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D012307:Risk Factors; D012944:Social Support; D013179:Spouse Abuse / Q000523:psychology; D016896:Treatment Outcome